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. 2014 Nov 7;9(11):1840-8.
doi: 10.2215/CJN.03460414. Epub 2014 Oct 15.

Contrast-associated AKI and use of cardiovascular medications after acute coronary syndrome

Kelvin C W Leung  1 , Neesh Pannu  2 , Zhi Tan  3 , William A Ghali  4 , Merril L Knudtson  1 , Brenda R Hemmelgarn  4 , Marcello Tonelli  1 , Matthew T James  5 ; APPROACH and AKDN Investigators
Affiliations

Contrast-associated AKI and use of cardiovascular medications after acute coronary syndrome

Kelvin C W Leung et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: AKI after coronary angiography is associated with poor long-term outcomes. The relationship between contrast-associated AKI and subsequent use of prognosis-modifying cardiovascular medications is unknown.

Design, setting, participants, & measurements: A cohort study of 5911 participants 66 years of age or older with acute coronary syndrome who received a coronary angiogram in Alberta, Canada was performed between November 1, 2002, and November 30, 2008. AKI was identified according to Kidney Disease Improving Global Outcomes AKI criteria.

Results: In multivariable logistic regression models, compared with participants without AKI, those with stages 1 and 2-3 AKI had lower odds of subsequent use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker within 120 days of hospital discharge (adjusted odds ratio, 0.65; 95% confidence interval, 0.53 to 0.80 and odds ratio, 0.34; 95% confidence interval, 0.23 to 0.48, respectively). Subsequent statin and β-blockers use within 120 days of hospital discharge was significantly lower among those with stages 2-3 AKI (adjusted odds ratio, 0.44; 95% confidence interval, 0.31 to 0.64 and odds ratio, 0.46; 95% confidence interval, 0.31 to 0.66, respectively). These associations were consistently seen in patients with diabetes mellitus, heart failure, low baseline eGFR, and albuminuria; 952 participants died during subsequent follow-up after hospital discharge (mean=3.1 years). The use of each class of cardiovascular medication was associated with lower mortality, including among those who had experienced AKI.

Conclusions: Strategies to optimize the use of cardiac medications in people with AKI after coronary angiography might improve care.

Keywords: ACE inhibitors; acute renal failure; cardiovascular.

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Figures

Figure 1.
Figure 1.
Cohort formation. Scr, serum creatinine.
Figure 2.
Figure 2.
Associations between AKI and use of cardiovascular medications in all study participants and specified subgroups. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; 95% CI, 95% confidence interval; OR, odds ratio.
Figure 3.
Figure 3.
Associations between use of cardiovascular medications and survival according to AKI status
See this image and copyright information in PMC

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References

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